Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati/Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Laryngoscope. 2011 May;121(5):929-32. doi: 10.1002/lary.21718.
OBJECTIVES/HYPOTHESIS: Temporal bone fractures (TBFs) are a frequent manifestation of head trauma. We investigated the prevalence of concurrent intracranial injuries (ICIs) and cervical spine injuries (CSIs) in a series of patients with TBFs and attempted to identify significant associations between current TBF classification systems and either ICI or CSI.
Retrospective case series with chart review.
The records of all patients ≥18 years of age diagnosed with a basilar skull fracture, including TBF, at a level I trauma center from 2004 to 2009 were reviewed. Patient demographics, mechanism of injury, and Glasgow Coma Scale (GCS) scores were collected. Imaging studies were reviewed to classify TBF using the traditional longitudinal-transverse-mixed and otic capsule-sparing versus -involving systems and identify concurrent ICI and CSI.
Of 1,279 patients, 202 (15.8%) met inclusion criteria. There were 160 (79.2%) males. Sixteen (7.9%) patients had bilateral TBFs. Falls (n = 66, 32.7%) represented the most common mechanism for TBF. Longitudinal (n = 96, 44.0%) and otic capsule-sparing (n = 209, 95.9%) fractures were the most prevalent subtypes. There were 184 (91.1%) patients who sustained ICI and 18 (8.9%) who demonstrated CSI. Longitudinal, transverse, mixed, otic capsule-sparing, or otic capsule-involving TBF subtypes had no statistically significant associations with mechanism of injury, GCS score, or concomitant ICI or CSI.
More than 90% of patients sustaining TBF presented with concomitant ICI, and 9% sustained CSI. Current TBF classification systems do not correlate with these outcomes. A more sophisticated, multidisciplinary classification system encompassing radiographic and clinical findings may better predict neurologic, neuro-otologic, and skull base complications.
目的/假设：颞骨骨折（TBFs）是头部外伤的常见表现。我们研究了一系列 TBF 患者中并发颅内损伤（ICIs）和颈椎损伤（CSIs）的患病率，并试图确定当前 TBF 分类系统与 ICI 或 CSI 之间的显著关联。
回顾性病例系列研究，病历回顾。
回顾 2004 年至 2009 年在一级创伤中心诊断为颅底骨折（包括 TBF）的所有年龄≥18 岁患者的记录。收集患者的人口统计学资料、损伤机制和格拉斯哥昏迷评分（GCS）。回顾影像学检查，使用传统的纵向-横向混合和耳囊保留与受累系统对 TBF 进行分类，并确定并发 ICI 和 CSI。
在 1279 名患者中，有 202 名（15.8%）符合纳入标准。其中 160 名（79.2%）为男性。16 名（7.9%）患者双侧 TBF。跌倒（n=66，32.7%）是 TBF 最常见的机制。纵向（n=96，44.0%）和耳囊保留（n=209，95.9%）骨折是最常见的亚型。184 名（91.1%）患者发生 ICI，18 名（8.9%）患者发生 CSI。纵向、横向、混合、耳囊保留或耳囊受累 TBF 亚型与损伤机制、GCS 评分或并发 ICI 或 CSI 无统计学显著关联。
超过 90%的 TBF 患者伴有并发 ICI，9%的患者伴有 CSI。当前的 TBF 分类系统与这些结果无关。一个更复杂的、多学科的分类系统，包括影像学和临床表现，可能更好地预测神经、神经耳科学和颅底并发症。
